Drug-Resistant Infections

Lord Hunt of Kings Heath Excerpts

Thursday 15th September 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to congratulate the noble Lord, Lord Lansley, on raising such an important and interesting Question for our debate today on the risks that we face, now and in the future, in relation to AMR. It is of course very timely, because of the imminence of the UN high-level meeting and also because of the work of the noble Lord, Lord O’Neill of Gatley, to whom I pay tribute—indeed, I am grateful to him for his summary of his report, which we received yesterday.

We have had the interim response to that report, and I understand that a full response is due shortly. Can the noble Lord, Lord Prior, say a little more about that full response and what he thinks might be in it? Can he also say a little more about the approach we are likely to take at the UN high-level meeting next week?

Noble Lords have referred to a lot of the recommendations of the noble Lord, Lord O’Neill; I will ask about two areas. The first relates to a global public awareness campaign. We know, as noble Lords have said this afternoon, that some have what can best be described as a cavalier approach to the use of antibiotics. I am interested to know what the UK’s approach is to negotiations on an international response, particularly on the need for a global public awareness campaign. The noble Baroness, Lady Walmsley, from her experience in Kolkata, intimated the kind of response that was possible, but we need a level of awareness for that to happen.

I also want to ask about work with the global finance and health community to develop a system that can reward pharmaceutical companies that develop new and successful antibiotics. I understand that the ABPI is working with the Minister’s department to create a UK model that would delink payments for antibiotics from volumes of sales, which would guarantee companies a return on investment. The current financial model does not provide the incentives that the companies need. Can the Minister say a little more about the progress that is being made in those discussions?

Vaccines have been mentioned by a number of noble Lords. I have had a comment from one of the companies that have briefed me—it was from Pfizer, in fact—that while the UK is a world leader in national immunisation programmes, its sense is that immunisation is not regarded by the Government as an,

“important component of its strategy to address AMR”.

Can the Minister confirm whether that is true or not? As Pfizer points out,

“This is despite evidence that improvements in vaccination could help to contain the rise of four different types of drug-resistant infections”.

The noble Lord, Lord Rees, very clearly set out the real risks faced, and he offered some interesting insights, I thought, into the use of prizes to stimulate solutions and to work up novel ideas. Does the Minister think that this might be something that is developed in the future?

We have heard a number of ideas. The noble Lord, Lord Colwyn, raised the issue of reactive oxygen. I am not sure that I entirely followed the technical details, but I got the point. He essentially said that there is a regulatory difficulty with its introduction. It would be interesting to know whether the Government are looking at this as a potential area for development.

I should also say that we have had an amazing amount of briefing for this debate. I was interested to hear from Brightwake the potential for using disinfectants as chemical agents, since they have excellent biocompatibility and can be used more on topical infections or wounds with a high risk of infection. Brightwake says that use in Germany has shown pre and post-surgical infections are the lowest recorded. My understanding is that there is a problem for manufacturers to get these agents through the regulatory process, because the cost of introducing a so-called “medical substance” into a medical device is very prohibitive.

None of us knows the impact of Brexit on the regulation of medicines and medical devices, but it might be worth looking at areas in which a speeded-up and rather more streamlined approach might be helpful in the future. Can the Minster’s department have a look at that?

The noble Baroness, Lady Hayman, made some very telling points about malaria and the all-party report. I think that she and I are both interested to know whether the Government will take forward the recommendations and how they will do so.

We have talked about what is to be done globally, but there is much that can still be done in this country. GPs are clearly at the front line in terms of the prescribing that they undertake, and my impression is that many of them have responded to the challenge but there is a clear variation in performance. I was interested in the reference by the noble Lord, Lord Colwyn, to veterinary surgeons and the guidance—or what I think is rather more than guidance—issued by the Royal College of Veterinary Surgeons; it sounded much more like a requirement in relation to their clinical practice. I wonder whether there is something to be learned there in relation to the inappropriate use of antibiotics in human medicine. Can the Minister comment on where we are with GPs and whether there are things that we can do, none the less, to improve their overall performance?

I also refer the Minister to a comment that I have received from the BMA:

“In hospitals it is often unclear which staff have ‘ownership’ of antimicrobial prescribing and responsibility for minimising resistance”.

That is very interesting because—as the noble Lord, Lord Lansley, referred to—it has clearly been important that, at the end of the day, both the board of the organisation and individual senior officials have a clear responsibility for infection control. I wonder whether we need a similar approach when it comes to antimicrobial prescribing.

Three speakers—the noble Earl, Lord Selborne, and the noble Lords, Lord Lansley and Lord Trees—spoke about the issue of animals. They made some very telling comments. The noble Lord, Lord Lansley, asked about veterinary supervision of the use of antibiotics in animals; he also referred to the inappropriate use of what might be described as the antibiotics of last resort in animals, which should be reserved only for humans—I think that there is a great deal of sympathy for that.

The noble Lord, Lord Trees, spoke of the responsible attitude of veterinary bodies in the UK and EU and the considerable progress that has been made over the past few years. I think that it is right to acknowledge that progress and to acknowledge the farming community as a whole for its general co-operation on those measures.

But what about countries where there is absolutely no control of the use of antibiotics in animals? Is the Minister confident that this will be tackled in future global negotiations and discussions because this is clearly a very worrying situation? I am not an expert on the international food trade, but one of the major concerns of UK farmers is that very high standards are required of them, whether in relation to the inappropriate use of antibiotics or on animal welfare, but they are forced to compete with countries which do not have these high standards. This is a very broad canvas, but clearly the issue of animals should be taken very seriously.

Overall, this has been an extremely constructive debate. I recognise that the Government, particularly under the previous Prime Minister, were taking a progressive approach in this area. I very much hope that this will continue under the current Prime Minister, and that we will see a wholehearted response to the report of the noble Lord, Lord O’Neill, very soon.